Project Abstract Medical Therapy Units (MTUs) are multidisciplinary county clinics that provide comprehensive medical management to children with special health care needs for durable medical equipment, orthotics, and therapy services. Unfortunately for children living in rural and underserved communities, MTU specialty care is often difficult to access because the most qualified specialist physicians to lead these encounters (pediatric physiatrists), are regionalized at large urban centers. As a result, these children are left to receive care in one of three ways: first, some pediatric physiatrists travel long distances to provide care in the local community MTU; second, some county MTUs hire non-specialist providers to provide the care, despite the fact that these providers lack expertise in the care of children with special health care needs; and third, some families and children are left with no other option but to travel long distances to receive care at a regionalized, urban MTU. In order to address the travel burdens and barriers to care, as well as to increase the quality of care provided to these children, we will implement a model of care using telemedicine to deliver pediatric physiatrist medical direction to MTUs located in rural and underserved communities. The objective of this application is to prospectively compare outcomes from our telemedicine-based model of care to two cohorts: patients who receive in-person pediatric physiatrist medical direction (the ?gold standard?) and patients who receive medical oversight from non-specialist community providers. First, we hypothesize that when pediatric physiatrists use telemedicine to provide medical direction, parents/guardians of children will be equally satisfied with care received compared to parents/guardians of children who receive in-person care by pediatric physiatrists, and more satisfied than parents/guardians of children who receive care by non-specialist community providers. Second, we hypothesize that when pediatric physiatrists use telemedicine to provide medical direction, children will have equal adherence to an evidence- based hip surveillance program compared to children who receive in-person care by pediatric physiatrists, and better adherence to the hip surveillance program than children who receive care by non-specialist community providers. Third, we hypothesize that when pediatric physiatrists use telemedicine to provide medical direction to children with special health care needs living in rural and underserved communities, there will be significant cost savings compared to when pediatric physiatrists have to travel to distant MTUs and to when care is provided by non-specialist community providers. Our work is significant because we expect that this model of care will result in improved access, increased levels of patient-centeredness, higher quality of care, and will simultaneously reduce overall costs of care. We also expect that this model will be scalable and will be used by similar programs treating children with special health care needs throughout the country. 1